My purpose in writing this book is to show what a social perspective is and how it helps to explain health and well-being, disorder and distress.¹ Clinicians, who are usually equipped with an individual rather than a social perspective on their patients, have been on my mind as I have worked on this manuscript, but I believe that anyone interested in the relationship between society and individual well-being will also learn something from what I have written here.

The perspective I present offers many clinicians an opportunity to understand patients in a way that they may not yet possess. Those...

Roles, social stratification, and the political-economic structure are three constructs that social scientists use to explore the relationship between individuals and society. They represent the contexts of society that pattern individualsʹ experiences – and lives – in complex interacting ways. Within this triad, I view the stratification system as the central component of a social perspective and social class as the dominant constituent of the stratification system. Roles are the daily expressions of the stratification system while economic and political circumstances have consequences for groups and individuals depending on their positions in the system of stratification.

The different roles we...

Social classes are groups of people who have access to similar resources over time. Inequality is a concept that describes differences in these resources at different levels of the social hierarchy, most commonly in terms of income and wealth. Lower socioeconomic status is correlated with a higher prevalence of almost all medical diseases and conditions (Antonovsky, 1967; Ilsley & Baker, 199l). This link between social status and morbidity and mortality is one of the strongest and most enduring findings in medicine and social science. That there is an association between socioeconomic status and health at every level of the socioeconomic hierarchy...

Class, however defined, embodies inequalities. This book argues that inequalities of health and well-being are largely reflections of social inequalities. This being the case, it is important to know what our system of inequalities – the class system – looks like, how it works, how it is maintained, who benefits from it, and who does not.

The concept of class has never had much currency in the United States. Historically, class awareness in America has had to struggle against the conviction that, as the Declaration of Independence puts it, ʹAll men are created equal.ʹ This has been misinterpreted to mean...

For almost thirty years after the Second World War, economic inequality in the United States declined, largely as a result of legislation enacted during the New Deal of the 1930s. During the war and particularly after it, all segments of the population experienced roughly equivalent gains in income, which were substantial. In the period between 1947 and 1973 family income rose 104% (Mishel et al., 2003). During this period America looked as if it were on its way to truly becoming a middle-class society. This changed in the 1970s, however, and America became much more polarized, economically and socially. Large...

Our embeddedness in society is illustrated concretely by our work roles. They largely define our social class, constitute a major part of our identity, and are at the centre of our daily lives. Our jobs command our best waking hours and determine what we do during them. Work provides structure and rhythm to our lives. It furnishes income, which gives access to opportunity, and has historically been linked to the availability of health insurance in the United States. It is in our roles at work that we relate most publicly to each other. Occupations define a whole set of experiences...

We know, as discussed in chapter 2, that lower class position is tied to more distress, more mental illness, and poorer physical health, just as we know that higher social status leads to better health. But these associations, which have now been confirmed so many times, now require explanation. What are the processes or mechanisms that account for the relationship between social position and health?

Health disparities reflect socioeconomic disparities. Where an individual is positioned in the stratification system by class, race, and gender has a great effect on the possession of particular resources that promote health and well-being. Blane...

In the previous chapters I have endeavoured to present a social perspective whose main aim is to show how the structure of society affects well-being and health. Well-being and health reflect differences in the distribution of important resources. The class system in America embodies inequalities of resources that have been pushed to extremes in recent years. This is the picture at the macro and meso levels. In this and the following chapters I want to give more attention to the micro level – to the clinician, the patient, and the interaction between the two – and show the effect of...

At the beginning of the book I mentioned that there were two reasons that a social perspective has been neglected in clinical work. The first was that it had not been clearly defined. I hope this is no longer the case. With an awareness of how the class system works, a grasp of why roles are important, and how economic policies and political decisions affect groups differently, a wider understanding of the individual should now be possible. I would now like to turn to the other reason that social perspective has been stunted: the psychiatricDiagnostic and Statistical Manual of...

In this chapter I show how a social perspective can be incorporated, first by description and then by example, into cliniciansʹ thinking in order to round out the conceptual framework that currently emphasizes biological and psychological approaches.

The first meeting between a clinician and a patient usually begins with the clinician asking the patient about the problem that brought him or her to seek professional help. This is followed by a survey of symptoms that are bothering the patient. Possible precipitating events are asked about as well as past psychiatric history, family history of psychiatric disorder, use of drugs and...

1 Social disparities produce health disparities.

2 The clinical professions have largely ignored the impact of social disparities on health and well-being.

These are the two sentences I would use if I were asked to condense this book. Throughout it I have emphasized that individuals are embedded in society through their roles shaped within the institutions of society, through the stratification system, and through their places as citizens subject to economic-political circumstances. Daily life is experienced through various roles, which bring satisfactions and strains. Stratification refers to a system of ranking individuals on hierarchies from high to low. The main...